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Asian Cardiovasc Thorac Ann 1999;7:331-332
© 1999 Asia Publishing EXchange Pte Ltd

HOW TO DO IT

Flexible Angle-Retaining Dual-Stage Venous Cannula

Kazuya Akiyama, MD, Arifumi Takazawa, MD, Naohito Taniyasu, MD, Hiroaki Sato, MD

Department of Cardiovascular Surgery Iwaki Kyoritsu General Hospital Fukushima, Japan
For reprint information contact: Kazuya Akiyama, MD Tel: 81 246 26 3151 Fax: 81 246 27 2148 Department of Cardiovascular Surgery, Iwaki Kyoritsu General Hospital, 16 Kusehara, Uchigo Mimayamachi, Iwaki City, Fukushima 973-8555, Japan.

   Abstract
TOP
 Abstract
Introduction
 Device and Technique
 Discussion
 References
 
We designed a flexible and angle-retaining dual-stage venous cannula by attachment of a U-shaped stainless steel wire, heat-contracted tube, and synthetic resins. Initial clinical use showed that this cannula has several benefits compared to a conventional fixed-angle cannula for establishing cardiopulmonary bypass for aortic root and coronary artery bypass surgery.


   Introduction
TOP
 Abstract
 Introduction
Device and Technique
 Discussion
 References
 
The straight dual-stage venous cannula is commonly used to establish cardiopulmonary bypass in adult cardio-vascular surgery and it has several advantages.1 The disadvantages are that it can interfere with the surgeon's view, it requires a long venous return circuit, and it has a tendency to dislodge. Therefore, a few models of fixed-angle cannulae have become commercially available.2–4 We have already published a report of the clinical use of an angle-adjustable sheath to bend a dual-stage venous cannula according to various surgical needs.5 We now describe a new dual-stage venous cannula that can be bent and retained at an angle determined by the surgeon's preference.


   Device and Technique
TOP
 Abstract
 Introduction
 Device and Technique
Discussion
 References
 
The flexibility and retention of the flexed angle is achieved by attaching a wire coil to the outer surface of the cannula. A Technowood venous cannula (Tonokura Ika Kogyo Co., Tokyo, Japan) with a tip to body relationship of 36F to 46F is reinforced with a U-shaped stainless steel wire coil of 26 cm in length and 1.5 mm in diameter. The closed end is curved to fit the outer surface of the dual-stage venous cannula and tightly fixed on the outer surface of the cannula. The open end is fixed by a thick layer of synthetic resin and the remaining portion is fixed by a heat-contracted tube made from vinylidene polyfluoride (Figure 1Go). These modifications give the cannula flexibility and the ability to retain its angle, with maximal bending to 45 degrees (Figure 2Go).



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  		Figure 1. Holder portion of the cannula. Stainless steel wire attached to the dual-stage venous cannula by synthetic resins and the heat-contractile tube.

 


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  		Figure 2. The dual-stage venous cannula bent to 45 degrees by the stainless steel holder.

 
The cannula is inserted through the right atrial appendage into the inferior vena cava until it is positioned between the first and second line markings in the usual fashion. The cannula must be rotated so that the wire faces into the curve of the cannula to achieve easy bending. During cannulation, the cannula must be bent in the caudal direction to avoid tearing the right atrial appendage, which can result in continuous entrance of air into the extra-corporeal circulation (Figure 3Go). Cannulation may also be performed after bending the cannula that can be easily inserted into the inferior vena cava due to its soft tip. Cardiopulmonary bypass can then be established as usual. We have used this cannula in 57 consecutive cases of aortic valve replacement, aortic root replacement, and coronary bypass surgery.



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  		Figure 3. Operative photograph of aortic valve replacement during cardiopulmonary bypass established via the cannula.

 

   Discussion
TOP
 Abstract
 Introduction
 Device and Technique
 Discussion
References
 
Fixed-angle cannulae do not always match the anatomical angle determined by the inferior vena cava, the right atrial appendage, and the caudal border of the sternal incision. This mismatch can cause trauma of the right atrial appendage at the time of cannulation and decreased venous return during cardiopulmonary bypass. Therefore, we consider that angle adjustability is very important to preserve the benefits of an angled venous cannula. The previously described angle-adjustable sheath for a dual-stage venous cannula is very useful but its increased diameter has the potential to interfere with the surgeon's view during small incisions in cardiac operations.5 In addition, cleaning the lumen of the sheath is troublesome because of the bellows-like configuration and its reuse has a potential risk of disease transmission. Therefore, we designed a flexible angle-retaining cannula based on the concept of the angle-adjustable sheath.

We routinely use this cannula in all patients undergoing aortic valve replacement, aortic root replacement, and coronary bypass surgery. From our clinical experience in 57 consecutive cases, the angle of 45 degrees achieved by maximum bending did not show any decrease in venous return and maximum flows during cardiopulmonary bypass of over 7 L•min–1 were obtained. Significant hemolysis due to turbulent flow in the angled cannula was not detected in comparisons with a conventional straight cannula. The improved field of view reduced the aortic crossclamp time in aortic root replacements and multiple coronary bypass grafting using saphenous vein grafts. The angle-retaining dual-stage venous cannula is a very effective and useful device for establishment of cardiopulmonary bypass.


   Acknowledgments
 
We are grateful to Mr. Jun Kato and Mr. Albert Mimaki of Tonokura Ika Kogyo Co. Ltd., Tokyo, Japan, for their cooperation in the production of this cannula.


   References
TOP
 Abstract
 Introduction
 Device and Technique
 Discussion
 References
 

  1. Riley JB, Hardin SB, Winn BA, Hurdle MB. In vitro comparison of cavoatrial (dual stage) cannulae for use during cardiopulmonary bypass. Perfusion 1986;1:197–204.

  2. Bugge M, Lepore V, Dahlin A. The "90° bent" two-stage venous cannula. Eur J Cardio-thorac Surg 1995;9:526–7.[Abstract]

  3. Lawrence DR, Desai JB. Forty-five-degree two-stage venous cannula: advantages over standard two-stage venous cannula. Ann Thorac Surg 1997;63:253–4.[Abstract/Free Full Text]

  4. Souza LSS. Ninety-degree two-stage venous cannula. Ann Thorac Surg 1997;64:1523–4.[Free Full Text]

  5. Akiyama K, Takazawa A, Maeda T, Akazawa T, Yamanishi H. Angle-adjustable sheath for a dual-stage venous cannula. Ann Thorac Surg 1999;67:862–3.[Abstract/Free Full Text]





This Article
Right arrow Abstract Freely available
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Right arrow Articles by Akiyama, K.
Right arrow Articles by Sato, H.

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